title: The patients' perception of prodromal symptoms before the initial diagnosis of Parkinson's disease.
abstract: BACKGROUND
  Before the occurrence of motor symptoms permits the clinical diagnosis of Parkinson's disease (PD), about or even more than 50% of the dopaminergic neurons of the substantia nigra have degenerated. This time be called the prodromal phase of PD.
  
  
  OBJECTIVE
  To evaluate the time span from onset of first prodromal symptoms to the initial diagnosis of PD as well as the order of symptom occurrence.
  
  
  METHODS
  Retrospective study of 93 consecutively interviewed PD patients without dementia and 93 sex and age matched controls free of neurodegenerative disorders. A standardized in-house telephone worksheet assessing 19 nonmotor and six early motor signs was used.
  
  
  RESULTS
  A total of 98.8% of all patients interviewed reported to have experienced prodromal symptoms prior to receiving the initial diagnosis of PD. Patients noticed an average of 7.6 different symptoms during this time interval. The mean time span between the recalled onset of any one symptom and PD diagnosis was 10.2 years. In both groups, the course of prodromal sign onset was associated with early neuropathological disease stages proposed by Braak.
  
  
  CONCLUSIONS
  These retrospectively gathered data confirm the existence of a long prodromal phase for PD that is consistent with neuropathological staging. A standardized questionnaire assessing such early symptoms may be helpful in identifying subjects at high risk for PD while they are still in the prodromal phase of the disorder.
authors.affiliation: Department of Neurodegeneration, Hertie Institute of Clinical Brain Research, Tübingen, Germany. alexandra.gaenslen@klinikum.uni-tuebingen.de
authors.forename: Alexandra
authors.initials: A
authors.lastname: Gaenslen
authors.forename: Irene
authors.initials: I
authors.lastname: Swid
authors.forename: Inga
authors.initials: I
authors.lastname: Liepelt-Scarfone
authors.forename: Jana
authors.initials: J
authors.lastname: Godau
authors.forename: Daniela
authors.initials: D
authors.lastname: Berg
mesh_terms: D000342:Affective Symptoms / Q000209:etiology; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications* / Q000523:psychology*; D010468:Perceptual Disorders / Q000175:diagnosis* / Q000209:etiology*; D012189:Retrospective Studies; D013997:Time Factors